Department of Internal Medicine, College of Medicine, World Health Organization Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul.
Clin Infect Dis. 2020 Jul 27;71(3):546-555. doi: 10.1093/cid/ciz860.
The effect of prophylactic antiviral therapy (AVT) on survival of patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) remains unknown. This study aimed to determine whether prophylactic AVT could improve long-term survival in patients undergoing transarterial chemotherapy (TAC).
Between 2002 and 2016, 2860 newly diagnosed HBV-related patients with HCC treated with TAC were screened to analyze 2 groups based on prophylactic use of antivirals. Treatment effects were analyzed using propensity score (PS) matching (1:1) separately for the entire cohort and each subgroup. The primary endpoint was overall survival.
A total of 1547 patients met the inclusion criteria and 1084 were PS matched for the 2 groups. Median follow-up duration was 16.55 months. In the entire unmatched cohort, patients receiving prophylactic AVT survived significantly longer than those who did not. Among AVT-untreated patients, baseline high viremia and HBV reactivation during treatment were significantly associated with shorter survival. Regarding types of antivirals, survival was significantly longer for patients receiving high-potency antivirals than those receiving low-potency antivirals. Survival differed with antiviral response. In the PS-matched cohort, the prophylactic AVT group survived significantly longer than the nonprophylactic group, irrespective of viral status or tumor stage. Prophylactic AVT remained an independent factor for survival. The association of prophylactic AVT with decreased risk of mortality persisted in patient subgroups after adjusting for baseline risk factors. Sensitivity analyses also confirmed estimated treatment effects.
Prophylactic AVT is associated with significantly improved long-term survival among patients undergoing TAC. High-potency antivirals are indicated for this approach.Hepatitis B virus-associated morbidity is a well-known complication during transarterial chemotherapy (TAC). Our large-scale study demonstrated that prophylactic therapy with high-potency antivirals provides a significantly better survival in TAC-treated patients, irrespective of baseline viremia status or tumor stage.
预防性抗病毒治疗（AVT）对乙型肝炎病毒（HBV）相关肝细胞癌（HCC）患者生存的影响尚不清楚。本研究旨在确定预防性 AVT 是否可以改善接受经动脉化疗（TAC）的患者的长期生存。
2002 年至 2016 年间，筛选了 2860 例接受 TAC 治疗的新诊断的 HBV 相关 HCC 患者，根据抗病毒药物的预防性使用将其分为 2 组。分别使用倾向评分（PS）匹配（1:1）对整个队列和每个亚组进行治疗效果分析。主要终点是总生存期。
共有 1547 例患者符合纳入标准，其中 1084 例患者进行了 PS 匹配。中位随访时间为 16.55 个月。在整个未匹配队列中，接受预防性 AVT 的患者比未接受 AVT 的患者存活时间明显更长。在未接受 AVT 治疗的患者中，基线高病毒血症和治疗期间的 HBV 再激活与较短的生存时间显著相关。关于抗病毒药物的类型，接受高效抗病毒药物治疗的患者的生存时间明显长于接受低效能抗病毒药物治疗的患者。生存情况因抗病毒反应而异。在 PS 匹配队列中，预防性 AVT 组的生存时间明显长于非预防性组，无论病毒状态或肿瘤分期如何。预防性 AVT 仍然是生存的独立因素。调整基线风险因素后，预防性 AVT 与降低死亡率的风险关联在患者亚组中仍然存在。敏感性分析也证实了治疗效果的估计。
预防性 AVT 可显著改善接受 TAC 治疗的患者的长期生存。对于这种方法，建议使用高效抗病毒药物。乙型肝炎病毒相关发病率是 TAC 期间众所周知的并发症。我们的大规模研究表明，无论基线病毒血症状态或肿瘤分期如何，接受高效抗病毒药物的预防性治疗可为接受 TAC 治疗的患者提供显著更好的生存。
